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General NPI Number Information
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NPI Number | 1366639163
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Entity Type | Organization
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Legal Business Name | OTTAVIANI CHIROPRACTIC CENTER LLC
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 11/23/2010
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Provider Practice Location Address
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Address Line | 1515 HERBERT ST STE 209
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City | PORT ORANGE
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State | FL
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Zip | 32129-6105
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Country | US
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Telephone | 386-366-9119
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 HERBERT ST STE 209
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City | PORT ORANGE
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State | FL
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Zip | 32129-6105
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Country | US
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Telephone | 386-366-9119
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREW OTTAVIANI
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Credential | D.C.
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Telephone | 386-366-9119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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